The Effects of Constraint-Induced Movement Therapy on Functions of Cerebral Palsy Children.

Objectives
Constraint-Induced Movement Therapy (CIMT) is an intervention method that can enhance cerebral palsy (CP) children's hand function. CP is a pervasive and common disorder which affects many aspects of a child life. Hemiplegic CP affects one side of a child's hand and has great effect on child's independence. We investigated the CIMT's studies conducted in Iran, and indicated the effectiveness of CIMT on duration and children age?


Materials & Methods
This systematic review was conducted using the electronic databases such as Medline PubMed, CINAHL, etc. performed from 1990 to 2016. Iranian and foreigner famous journals in the fields of pediatrics such as Iranian Journal of Pediatrics (IJP), Iranian Rehabilitation Journal (IRJ) and Google scholar with some specific keywords such as CP, CIMT, and occupational therapy were searched.


Results
Overall, 43 articles were found, from which, 28 articles were removed because of lack of relevancy. Ten article were omitted because of duplication and exclusion criteria, so finally 15 articles were included.


Conclusion
CIMT is effective compared to no intervention but there are some inconsistencies regarding some parts of CIMT effectiveness such as its effectiveness on muscle tone and protective extension.

ability, hypertonia, changed proprioception and decreased selective motor control (13). These children not only feel limitation in their capacity but also tend to limit the affected limb usage in daily routines activities. The desire for less use of affected limb in developing children is called developmental disregard (14). Developmental disregard can be seen as inability to use hand or affected limb potentials in daily routines activities.
It generally has been compared with learned nonuse, which is a phenomenon can occur after stroke (15, 16).
CIMT is a deviation from traditional treatments, used to treat hemiplegia. Its aim is to stimulate the functional use of the affected limb and reverse the process developmental is disregard (17). In this method, the unaffected or less affected limb is restrained, so the person has to use the affected limb.
This method has risen up out of the intersection of behavioral brain research/learning hypothesis and disclosures in neuroscience with respect to neuroplasticity. CIMT is a kind of paradigm shift in rehabilitation of central nervous system injuries. It changes the paradigm from emphasis on compensatory skills to a desire for partial restoration (18). CIMT is the most convincing clinical treatment to improve sensory and mobility functions in hemiplegic CP children (13,19).
Two possible mechanisms may lead to more use of the affected limb (Overcoming developmental disregard). These two are a) Overcoming the learned non-use of the more affected arm (for example increased use of the more affected arm) and b) use-dependent cortical reorganization. By using Trans cranial Magnetic Stimulation (TMS), motor cortex mapping before and after CIMT were studied and the increase of motor output area size

Materials & Methods
This study was a systematic evidence-based study.
Searches was performed from 1990 to 2016.
Following sources were used for data gathering.

Results
Overall, 43 articles were found, because of lack of relevancy and other issues the 18 articles were removed. Ten articles were omitted based on duplication and exclusion criteria, so finally 15 articles were included (Table 1). CIMT has a good effect on protective extension.
It was not effective on protective extension (32); however, it was effective on protective extension Follow-ups are an important aspect of rehabilitation intervention. Less than half of the studies had included follow-up in their method. In the end, if we consider hands as brain's tool for independence in everyday activities more attention has to be paid on follow-ups and other occupational aspects.

Acknowledgement
No funding was secured for this study

Author`s Contribution
Malek Amini: conceptualized the study, helped in literature review, and approved the final manuscript as submitted.
Ali Reza Jamali: carried out the literature review, collected the data, wrote the manuscript.
The authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
All authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Conflict of interest
The authors declare that there is no conflict of interests.  37. Ghanbary S, Kavoosipor S, Alipor A.